MEDICARE: LISA VIVEIROS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	6030	MA
2	225200000X	Physical Therapy Assistant	0929	NH
3	225200000X	Physical Therapy Assistant	PTA00474	RI

General Provider Information

NPI Number	:	1053565408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA VIVEIROS

Provider Business Mailing Address
First Line	:	161 MOUNTFAIR CIRCLE
Second Line	:
City	:	SWANSEA
State	:	MA
Zip	:	02777-1000
Country	:	US
Telephone Number	:	508-674-2744
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 CENTER ST
Second Line	:
City	:	NORTH DIGHTON
State	:	MA
Zip	:	02764-1710
Country	:	US
Telephone Number	:	508-669-6741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	11/12/2008

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Directions to “ LISA VIVEIROS ” Practice Location

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